Caries Risk Assessment and Referral Tool (CRA-RT)-A novel risk scoring system for early childhood caries in community settings.

OBJECTIVE: To develop a brief and simple, easy-to-administer, culturally sensitive, reliable and valid risk scoring system for early childhood caries based only on behavioural and other nonclinical risk factors. The purpose was to allow risk scoring by child care providers without clinical examination in order to guide dental referral in a community setting. METHODS: A cross-sectional study using stratified multistage cluster sampling was conducted among 559 preschool children and their mothers in Anganwadi centres and Preprimary schools in Thiruvananthapuram district, Kerala, India. All steps in the development of a new tool were carried out. Exploratory factor analysis and principal component analysis with Varimax rotation were employed for item reduction. Reliability and validity assessments were also performed. Past caries experience was recorded as dmft scores and the validity hypothesis of higher dmft scores in children with higher caries risk scores was also verified as an additional measure of construct validity. RESULTS: The newly developed Caries Risk Assessment and Referral Tool (CRA-RT) is presented as a unidimensional, 11-item, discriminative tool which showed high test-retest reliability (ICC = 0.8), high inter-rater reliability (ICC = 0.8) and acceptable internal consistency (Cronbach's alpha = 0.6). Face, content and construct validity have been demonstrated. Children with higher CRA-RT scores were having higher dmft scores, and it provided an additional evidence for the construct validity of the tool. CONCLUSION: CRA-RT is a simple, valid and reliable novel risk scoring system for ECC, to be used in a nondental, nonmedical setting. The proposed tool contains those behavioural risk or protective factors, the presence or absence of which could be assessed by interviewing the mother. The quick and the easy risk scoring pattern with a cut-off score can guide the dental referral of preschool children by child care providers in a community setting.

Development and initial validation of an oral health-related quality of life scale for older adolescents.

BACKGROUND: Oral health-related quality of life (OHRQoL) perception is age-dependent and therefore different for children, adolescents, and adults. Adolescents are a critical age group with specific oral health needs. Oral health needs assessment is not complete without the estimation of OHRQoL. OBJECTIVE: To develop and validate an OHRQoL scale for older adolescents considering their functional, social, emotional, academic, and economic situation. METHODS: All steps in psychometric tool development including face, content, and translational validity, pretesting, piloting, and factor analysis were followed. Construct validity was further tested using a cross-sectional study on 400 senior secondary students. Sociodemographic data, Decayed Missing Filled Teeth, Dental Aesthetic Index, and Community Periodontal Index were used to test construct validity. RESULTS: A 20-item tool with five domains (intraclass correlation of 0.857, Cronbach's alpha of 0.811, variance of 64.25%) was developed. Convergent validity was established with a single-item global question and discriminant validity with clinical indices. In the multivariate logistic regression model, malocclusion emerged as the most significant predictor for poor OHRQoL adjusting for socioeconomic status, dental caries, gingival bleeding, and last dental visit. Dental caries and last dental visit also significantly predicted poor OHRQoL in the adjusted regression model. CONCLUSION: The new tool has sound psychometric properties, is relatively short, culturally equivalent, age-specific, and can assess both positive and negative aspects of adolescent oral health. Further testing in longitudinal studies is required to determine its usefulness as an outcome measure.

Oral Health and Quality of Life: Current Concepts.

The recognition of health related quality of life began ever since WHO expanded the definition of health in 1948. This has resulted in the paradigm shift of health and disease from a medical model to a biopsychosocial model. Oral health too denotes not merely the absence of disease but the general well being so that the person can perform functions like eating, talking and smiling and also can contribute creatively to the society. Health related quality of life is a trade-off between how long and how well people live. To explain the concept various theoretical models have been proposed, of which the conceptual model of Wilson and Cleary 1995 is a comprehensive one. Even after much research and thousands of publications the definition of oral health related quality of life is still vague. But the patient's self perception about his oral health and related life quality are significant in clinical dental practice, dental education and research. It is widely shown that oral conditions can have varied impacts on daily living. To assess this, many measures or scales are available. They differ depending on the response format, number of items, context of use and the population in which it is applied. Patient reported outcome assessment is a less developed area in clinical dentistry and research and in future it has the potential to become the primary or secondary outcome measure in clinical interventional research.

What makes a tool appropriate to assess patient-reported outcomes of periodontal disease?

CONTEXT: Patient-reported outcomes (PROs) have become primary or secondary outcome measure in clinical trials and epidemiological studies in Medicine and Dentistry in general and Periodontology in particular. PROs are patients' self-perceptions about consequences of a disease or its treatment. They can be used to measure the impact of the disease or the effect of its treatment. There are insufficient data in Periodontology related to scale development methodology although, recently, there is an increase in the number of published studies utilizing such tools in major journals. AIM: This paper is an overview of the development methodology of new PRO tools to study the impact of periodontal disease. MATERIALS AND METHODS: The iterative process begins with a research question. A well-constructed a priori hypothesis enables validity assessment by hypothesis testing. The qualitative steps in item generation include literature review, focus group discussion, and key informant interviews. Expert paneling, content validity index, and pretesting are done to refine and sequence the items. Test-retest reliability, inter-rater reliability, and internal consistency reliability are assessed. The tool is administered in a representative sample to test construct validity by factor analysis. CONCLUSION: The steps involved in developing a subjective perception scale are complicated and should be followed to establish the essential psychometric properties. The use of existing tool, if it fulfills the research objective, is recommended after cross-cultural adaptation and psychometric testing.